BMJ 2000;321:931-933 ( 14 October )

General Practice

Effect of needle length on incidence of local reactions to routine immunisation in infants aged 4 months: randomised controlled trial

Linda Diggle, senior research nurse, ^a Jonathan Deeks, senior medical statistician. ^b

^a Oxford Vaccine Group, University Department of Paediatrics, John Radcliffe Hospital, Oxford OX3 9DU, ^b ICRF/NHS Centre for Statistics in Medicine, Institute of Health Sciences, University of Oxford, Oxford OX3 7LF

Correspondence to: L Diggle linda.diggle{at}paediatrics.oxford.ac.uk

Objective: To compare rates of local reactions associated with two needle sizes used to administer routine immunisations to infants.
Design: Randomised controlled trial.
Setting: Routine immunisation clinics in eight general practices in Buckinghamshire.
Participants: Healthy infants attending for third primary immunisation due at 16 weeks of age: 119 infants were recruited, and 110 diary cards were analysed.
Interventions: Immunisation with 25 gauge, 16 mm, orange hub needle or 23 gauge, 25 mm, blue hub needle.
Main outcome measures: Parental recordings of redness, swelling, and tenderness for three days after immunisation.
Results: Rate of redness with the longer needle was initially two thirds the rate with the smaller needle (relative risk 0.66 (95% confidence interval 0.45 to 0.99), P=0.04), and by the third day this had decreased to a seventh (relative risk 0.13 (0.03 to 0.56), P=0.0006). Rate of swelling with the longer needle was initially about a third that with the smaller needle (relative risk 0.39 (0.23 to 0.67), P=0.0002), and this difference remained for all three days. Rates of tenderness were also lower with the longer needle throughout follow up, but not significantly (relative risk 0.60 (0.29 to 1.25), P=0.17).
Conclusions: Use of 25 mm needles significantly reduced rates of local reaction to routine infant immunisation. On average, for every five infants vaccinated, use of the longer needle instead of the shorter needle would prevent one infant from experiencing any local reaction. Vaccine manufacturers should review their policy of supplying the shorter needle in vaccine packs.

---

© BMJ 2000
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Effect of needle size on immunogenicity and reactogenicity of vaccines in infants: randomised controlled trial

Linda Diggle, Jonathan J Deeks, and Andrew J Pollard
BMJ 2006 333: 571. [Abstract] [Full Text] [PDF]

Needle length and incidence of local reactions to immunisation

John Platt, Barry Gibson-Smith, Mando Watson, Linda Diggle, Jonathan Deeks, and Ulrich Heininger
BMJ 2001 322: 492. [Extract] [Full Text]

Something practical, something ethical, something ludicrous
BMJ 2000 321: 0. [Full Text] [PDF]

Something practical, something ethical, something ludicrous
BMJ 2000 321: 0. [Full Text] [PDF]

Longer needles produce fewer local reactions during infant immunisation
BMJ 2000 321: 0. [Full Text]

This article has been cited by other articles:

• Koster, M. P., Stellato, N., Kohn, N., Rubin, L. G. (2009). Needle Length for Immunization of Early Adolescents as Determined by Ultrasound. Pediatrics 124: 667-672 [Abstract] [Full text]  
• Lippert, W. C., Wall, E. J. (2008). Optimal Intramuscular Needle-Penetration Depth. Pediatrics 122: e556-e563 [Abstract] [Full text]  
• Jackson, L. A., Starkovich, P., Dunstan, M., Yu, O., Nelson, J., Dunn, J., Rees, T., Zavitkovsky, A., Maus, D., Froeschle, J. E., Decker, M. (2008). Prospective Assessment of the Effect of Needle Length and Injection Site on the Risk of Local Reactions to the Fifth Diphtheria-Tetanus-Acellular Pertussis Vaccination. Pediatrics 121: e646-e652 [Abstract] [Full text]  
• Datta, M. (2007). Vaccinating infants with a wide long needle was non-inferior to a narrow short needle for immune response. EDUCATION AND PRACTICE 92: ep160-ep160 [Full text]  
• Schechter, N. L., Zempsky, W. T., Cohen, L. L., McGrath, P. J., McMurtry, C. M., Bright, N. S. (2007). Pain Reduction During Pediatric Immunizations: Evidence-Based Review and Recommendations. Pediatrics 119: e1184-e1198 [Abstract] [Full text]  
• Datta, M. (2007). Vaccinating infants with a wide long needle was non-inferior to a narrow short needle for immune response. Evid. Based Med. 12: 41-41 [Full text]  
• Carter-Arrowsmith, P. (2007). Vaccinating infants with a wide long needle achieved comparable immune response and reduced local reactions compared with a narrow short needle. Evid. Based Nurs. 10: 43-43 [Full text]  
• Diggle, L., Deeks, J. J, Pollard, A. J (2006). Effect of needle size on immunogenicity and reactogenicity of vaccines in infants: randomised controlled trial. BMJ 333: 571- [Abstract] [Full text]  
• Scott Richardson, W, Dowding, D. (2005). Teaching evidence-based practice on foot. Evid. Based Nurs. 8: 100-103 [Full text]  
• Hammer, S. J., Backer, H., Schechter, R. (2004). Immunization Injections. Arch Pediatr Adolesc Med 158: 708-708 [Full text]  
• Diggle, L, Deeks, J (2002). The Position Statement on Injection Technique. Arch. Dis. Child. 87: 452-453 [Full text]  
• Forster, J. (2001). Routine primary immunisation using a longer needle resulted in fewer local reactions in infants. Evid. Based Med. 6: 117-117 [Full text]  
• Van Berkel, C. (2001). Routine primary immunisation using a longer needle resulted in fewer local reactions in infants. Evid. Based Nurs. 4: 41-41 [Full text]  
• Platt, J., Gibson-Smith, B., Watson, M., Diggle, L., Deeks, J., Heininger, U. (2001). Needle length and incidence of local reactions to immunisation. BMJ 322: 492-492 [Full text]  
• (2000). Needle Length and Immunizations. JWatch General 2000: 6-6 [Full text]  

Rapid Responses:

Read all Rapid Responses

Further study required before change in practice

Barry Gibson-Smith
bmj.com, 19 Oct 2000 [Full text]

Needle gauge more important than needle length

Mando Watson
bmj.com, 19 Oct 2000 [Full text]

Authors response

Linda Diggle, et al.
bmj.com, 21 Oct 2000 [Full text]

What about other reactions?

Ulrich Heininger
bmj.com, 23 Oct 2000 [Full text]

The deeper, the better? Not necessarily

Laubscher Bernard
bmj.com, 17 Nov 2000 [Full text]

Aspiration before injection

Pamela Wray
bmj.com, 22 Nov 2000 [Full text]

thinner needles hurt less

Michael Snaith
bmj.com, 8 Mar 2001 [Full text]

Online poll

Find out more >>